Inferior Nasalabial Flap
a Patient With a Nasal Skin Carcinoma
This flap is difficult to achieve a
good cosmetic result in a single stage. Due to both swelling and
the thickness of the flap most patients will require a second-stage
reduction rhinoplasty. With wide flaps the closure of the secondary
defect can also distort the nose. With superiorly based flaps, the
defect is next to the nasal ala and closure under tension may spread
the nasal opening laterally. With inferiorly based flaps, the
defect is superiorly, and this can result is notching or wrinkling
of the nasal ala as the superior nasal skin is pulled laterally.
Indications for use of this flap is the loss of the nasal rim, loss
of the nasal supporting cartilages (only nasal mucosa lines the
depths of the resection), and a through and through defect. If the
resection is not deep, a skin graft, if possible a full thickness
graft, may be the better option since nasal distortion and flap
swelling are then avoided. A inferiorly based flap tends to swell
less than a surperiorly based flap. Full thickness skin
grafts give a better cosmetic result than a nasal labial flap but
should only be used for small superficial defects.
This flap is often classified as an
axial flap because there is a named artery which runs deep to the
flap (angular artery). However, when used for nasal reconstruction
the flap is thinned and does not contain the artery which is much
deeper in the tissues. In general, random flaps should not have a
length to width ratio greater that 2.5 to 1. Flaps wider than 1.5
cm may create a donor site which is difficult to close primarily.
In one patient, a width to length ratio of 3 to 1 was used, which
resulted in partial loss of the tip of the flap. The angular
artery, a branch of the facial artery (external carotid artery
system) runs deep to this flap.
Inferiorly based nasolabial flaps can
be used to reconstruct lower nasal defects. Because of the larger
angle of rotation, dog-ear formation is more likely to occur.
However, when an inferiorly based nasolabial flap is
used to reconstruct nasal alar defects this dog ear tends to blend
into the contour of the nasal ala. Because the base is
inferior, these flaps have better lymphatic drainage and less